1
|
Markus B, Kreutz J, Chatzis G, Syntila S, Choukeir M, Schieffer B, Patsalis N. Monitoring a Mystery: The Unknown Right Ventricle during Left Ventricular Unloading with Impella in Patients with Cardiogenic Shock. J Clin Med 2024; 13:1265. [PMID: 38592106 PMCID: PMC10931749 DOI: 10.3390/jcm13051265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Right ventricular (RV) dysfunction or failure occurs in more than 30% of patients in cardiogenic shock (CS). However, the importance of timely diagnosis of prognostically relevant impairment of RV function is often underestimated. Moreover, data regarding the impact of mechanical circulatory support like the Impella on RV function are rare. Here, we investigated the effects of the left ventricular (LV) Impella on RV function. Moreover, we aimed to identify the most optimal and the earliest applicable parameter for bedside monitoring of RV function by comparing the predictive abilities of three common RV function parameters: the pulmonary artery pulsatility index (PAPi), the ratio of right atrial pressure to pulmonary capillary wedge pressure (RA/PCWP), and the right ventricular stroke work index (RVSWI). Methods: The data of 50 patients with CS complicating myocardial infarction, supported with different flow levels of LV Impella, were retrospectively analyzed. Results: Enhancing Impella flow (1.5 to 2.5 L/min ± 0.4 L/min) did not lead to a significant variation in PAPi (p = 0.717), RA/PCWP (p = 0.601), or RVSWI (p = 0.608), indicating no additional burden for the RV. PAPi revealed the best ability to connect RV function with global hemodynamic parameters, i.e., cardiac index (CI; p < 0.001, 95% CI: 0.181-0.663), pulmonary capillary wedge pressure (PCWP; p = 0.005, 95% CI: -6.721--1.26), central venous pressure (CVP; p < 0.001, 95% CI: -7.89-5.575), and indicators of tissue perfusion (central venous oxygen saturation (SvO2); p = 0.008, 95% CI: 1.096-7.196). Conclusions: LV Impella does not impair RV function. Moreover, PAPi seems to be to the most effective and valid predictor for early bedside monitoring of RV function.
Collapse
Affiliation(s)
- Birgit Markus
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
| | - Julian Kreutz
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
| | - Giorgios Chatzis
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
| | - Styliani Syntila
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
| | - Maryana Choukeir
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
| | - Bernhard Schieffer
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
| | - Nikolaos Patsalis
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
| |
Collapse
|
2
|
Zuin M, Rigatelli G, Roncon L, Zuliani G. Relationship between echocardiographic tricuspid annular plane systolic excursion and mortality in COVID-19 patients: A Meta-analysis. Echocardiography 2021; 38:1579-1585. [PMID: 34355816 PMCID: PMC8444717 DOI: 10.1111/echo.15175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/22/2021] [Accepted: 07/31/2021] [Indexed: 12/11/2022] Open
Abstract
Background The evaluation of the tricuspid annular plane systolic excursion (TAPSE) is recommended to assess the right ventricular (RV) systolic function. We performed an updated meta‐analysis of the association between TAPSE and short‐term mortality in COVID‐19 patients. Methods MEDLINE and Scopus databases were searched to locate all the articles published up to May 1, 2021, reporting data on TAPSE among COVID‐19 survivors and non‐survivors. The difference of TAPSE between the two groups was expressed as mean difference (MD) with the corresponding 95% confidence interval (CI) using the Mantel‐Haenszel random effects model. Both Q value and I2 statistics were used to assess heterogeneity across studies. Sensitivity analysis, meta‐regression, and evaluation of bias were performed. Results Twelve studies, enrolling 1272 COVID‐19 patients (778 males, mean age 69.3 years), met the inclusion criteria and were included in the final analysis. Non‐survivors had a lower TAPSE compared to survivors (MD = −3.089 mm, 95% CI = −4.087 to −2.091, p < 0.0001, I2 = 79.0%). Both the visual inspection of the funnel plot and the Egger's tests (t = 1.195, p = 0.259) revealed no evidence of publication bias. Sensitivity analysis confirmed yielded results. Meta‐regression analysis evidenced that the difference in TAPSE between the two groups was only influenced by pre‐existing chronic obstructive pulmonary disease (COPD, p = 0.02). Conclusion COVID‐19 non‐survivors have a lower TAPSE when compared to survivors, especially in COPD subjects. Current data suggest that the TAPSE assessment may provide useful information regarding the short‐term prognosis of COVID‐19 patients during the infection.
Collapse
Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | | | - Loris Roncon
- Department of Cardiology, Rovigo General Hospital, Rovigo, Italy
| | - Giovanni Zuliani
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| |
Collapse
|
3
|
Gual-Capllonch F, Lupón J, Bancu I, Graterol F, Ferrer-Sistach E, Teis A, Santiago-Vacas E, Vallejo N, Juncà G, Bayes-Genis A. Preload dependence of pulmonary haemodynamics and right ventricular performance. Clin Res Cardiol 2021; 110:591-600. [PMID: 33624153 DOI: 10.1007/s00392-021-01820-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/08/2021] [Indexed: 11/25/2022]
Abstract
AIMS Systolic pulmonary artery pressure (SPAP) and right heart adaptation in relation to pre-existing preload are often disregarded. To determine volume-related changes in the pulmonary-right ventricle (RV) unit and the preload dependence of its components, we analysed pulmonary haemodynamics and right ventricular performance, taking advantage of the plasma volume removal associated to haemodialysis (HD). METHODS AND RESULTS Fifty-three stable patients on chronic HD with LVEF > 50% and without heart failure were recruited (mean age 63.0 ± 12.4 years; 31.2% women; hypertension in 89% and diabetes in 53%) and evaluated just before and after HD (mean ultrafiltration volume 2.4 ± 0.7 l). SPAP from both times were available in 39 patients. After HD, SPAP decreased (42.2 ± 12.6 to 33.7 ± 11.6 mmHg, p < 0.001) without modification of non-invasive pulmonary vascular resistance (1.75 ± 0.44 to 1.75 ± 0.40 eWU, p = 0.94). Age and drop in the E/e' ratio were the variables associated with greater reduction in PASP (p = 0.022 and p = 0.049, respectively). A significant reduction of right chamber sizes was observed, along with a diminution in measures of RV contractility, excluding RV longitudinal strain. Functional tricuspid regurgitation (FTR) diminution was observed in 26% of patients, occurring in every case with more than mild FTR. On multivariate analyses, left atrial size was the only predictor of pulmonary hypertension (defined as SPAP > 40 mmHg) (OR 1.29 (1.07-1.56), p = 0.006). CONCLUSION Rapid volemic changes may affect FTR grading, RV size and contractility, with RV longitudinal strain being less variable than conventional parameters. SPAP decreases after HD, and this reduction is related to age and greater diminution of the E/e' ratio.
Collapse
Affiliation(s)
- Francisco Gual-Capllonch
- Heart Institute. Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n 08916, Badalona, Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Josep Lupón
- Heart Institute. Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n 08916, Badalona, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Ioana Bancu
- Nefrology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Fredzzia Graterol
- Nefrology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Elena Ferrer-Sistach
- Heart Institute. Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n 08916, Badalona, Barcelona, Spain
| | - Albert Teis
- Heart Institute. Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n 08916, Badalona, Barcelona, Spain
| | - Evelyn Santiago-Vacas
- Heart Institute. Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n 08916, Badalona, Barcelona, Spain
| | - Nuria Vallejo
- Heart Institute. Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n 08916, Badalona, Barcelona, Spain
| | - Gladys Juncà
- Heart Institute. Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n 08916, Badalona, Barcelona, Spain
| | - Antoni Bayes-Genis
- Heart Institute. Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n 08916, Badalona, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
4
|
Cao Y, Singh V, Wang A, Zhang L, He T, Su H, Wei R, Duan Y, Jiang K, Wu W, Huang Y, Elmariah S, Qi G, Su X, Zhang Y, Zhang M. Meta-analysis of right ventricular function in patients with aortic stenosis after transfemoral aortic valve replacement or surgical aortic valve replacement. Ther Adv Chronic Dis 2020; 11:2040622320933775. [PMID: 32670537 PMCID: PMC7339069 DOI: 10.1177/2040622320933775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 05/12/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Right ventricular function (RVF) is an independent predictor of prognosis for
patients undergoing aortic valve replacement: transcatheter aortic valve
replacement (TAVR) or surgical aortic valve replacement (SAVR). The effect
of transfemoral aortic valve replacement (TF-TAVR) on RVF is uncertain. We
aimed to perform a meta-analysis of the effect of TF-TAVR on RVF in patients
with aortic stenosis (AS) and compare the effect of TF-TAVR with SAVR. Methods: We searched relevant studies from PubMed, Embase, Cochrane Library databases,
and Web of Science. Furthermore, two reviewers (Wang AQ and Cao YS)
extracted all relevant data, which were then double checked by another two
reviewers (Zhang M and Qi GM). We used the forest plot to present results.
Tricuspid annular plane systolic excursion (TAPSE) was the primary
outcome. Results: This meta-analysis included 11 studies. There were 353 patients who underwent
TF-TAVR, and 358 patients who were subjected to SAVR. There was no
significant difference in TAPSE at 1 week and 6 months as well as right
ventricular ejection fraction (RVEF) at <2 weeks and 6 months after
TF-TAVR. For the SAVR group, TAPSE at 1 week and 3 months as well as
fractional area change (FAC) at 3 months post procedure were significantly
aggravated, while RVEF did not change significantly. Moreover, TAPSE
post-TF-TAVR was significantly improved as compared with post-SAVR. The
△TAPSE, the difference between TAPSE post-procedure and TAPSE prior to
procedure, was also significantly better in the TF-TAVR group than in the
SAVR group. Conclusion: RVF was maintained post TF-TAVR. For SAVR, discrepancy in the measured
parameters exists, as reduced TAPSE indicates compromised longitudinal RVF,
while insignificant changes in RVEF implicate maintained RVF post procedure.
Collectively, our study suggests that the baseline RV dysfunction and the
effect of TF-TAVR versus SAVR on longitudinal RVF may
influence the selection of aortic valve intervention.
Collapse
Affiliation(s)
- Yunshan Cao
- Department of Cardiology, Gansu Provincial Hospital, No. 204, Donggang West Road, Chengguan District, Lanzhou, Gansu 730000, China
| | - Vikas Singh
- Division of Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Aqian Wang
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou, China
| | - Liyan Zhang
- Clinical Medicine School, Gansu University of Chinese Medicine, Lanzhou, China
| | - Tingting He
- Clinical Medicine School, Gansu University of Chinese Medicine, Lanzhou, China
| | - Hongling Su
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou, China
| | - Rong Wei
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou, China
| | - Yichao Duan
- School of Clinical Medicine, Ningxia Medical University, Ningxia, China
| | - Kaiyu Jiang
- Clinical Medicine School, Gansu University of Chinese Medicine, Lanzhou, China
| | - Wenyu Wu
- School of Clinical Medicine, Ningxia Medical University, Ningxia, China
| | - Yan Huang
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou, China
| | - Sammy Elmariah
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School Boston, MA, USA
| | - Guanming Qi
- Pulmonary and Critical Care Division, Tufts Medical Center, Boston, MA, USA
| | - Xin Su
- Clinical Medicine School, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yan Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Center of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, No. 251, Fukang Road, Nankai District, Tianjin, China
| | - Min Zhang
- Department of Pathology, Gansu Provincial Hospital, No.204, Donggang West Road, Chengguan District, Lanzhou, Gansu 730000, China
| |
Collapse
|
5
|
Sargsyan LA, Faiz SA. Pulmonary Hypertension in an Oncologic Intensive Care Unit. ONCOLOGIC CRITICAL CARE 2020. [PMCID: PMC7123640 DOI: 10.1007/978-3-319-74588-6_47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Pulmonary hypertension (PH) is the condition of elevated pressures in the pulmonary circulation. PH can develop acutely in patients with critical illness such as acute respiratory distress syndrome, sepsis, massive pulmonary embolism, left ventricular dysfunction, or after surgery. In a cancer patient, unique etiologies such as myeloproliferative disorders, tyrosine kinase inhibitors, or tumor emboli may result in PH. Early recognition and treatment of the causative condition may reverse acute PH or return chronic PH to its baseline status. Progression of the disease or its decompensation due to infection, a thromboembolic event, or other triggers can lead to admission to an intensive care unit. Regardless of etiology, the development or worsening of PH may precipitate hypoxemia, hemodynamic instability, or right ventricular failure, which can be challenging to manage or even fatal. In select cases, rapid institution of advanced treatment modalities may be warranted. This chapter reviews the etiology, epidemiology, pathophysiology, clinical features, diagnosis, and prognosis of PH and presents a comprehensive analysis of PH and right heart failure management strategies in the critical care setting. In particular, a unique perspective on oncologically relevant PH is provided.
Collapse
|
6
|
Abstract
Temporary mechanical circulatory support (MCS) devices have a role in treating high-risk patients with pulmonary embolism with cardiogenic shock. Mechanical circulatory device selection should be made based on center experience and device-specific features. All current devices are effective in decreasing right arterial pressure and providing circulatory support of 4 to 5 L/min. The pulmonary artery pulsatility index may prove to be an unreliable method to assess right ventricular function. Careful clinical evaluation on an individual patient basis should determine the need for MCS.
Collapse
|
7
|
Bonta DV, Aarsvold JN. Planar Computational Phantom for Modeling First-Pass Scintigraphic Measurement of Right Ventricular Ejection Fraction. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2019. [DOI: 10.1109/trpms.2018.2833629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
8
|
Liu J, Fei L, Huang GQ, Shang XK, Liu M, Pei ZJ, Zhang YX. Right ventricle performances with echocardiography and 99mTc myocardial perfusion imaging in pulmonary arterial hypertension patients. Exp Biol Med (Maywood) 2018; 243:754-761. [PMID: 29763366 DOI: 10.1177/1535370218775321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Right heart catheterization is commonly used to measure right ventricle hemodynamic parameters and is the gold standard for pulmonary arterial hypertension diagnosis; however, it is not suitable for patients' long-term follow-up. Non-invasive echocardiography and nuclear medicine have been applied to measure right ventricle anatomy and function, but the guidelines for the usefulness of clinical parameters remain to be established. The goal of this study is to identify reliable clinical parameters of right ventricle function in pulmonary arterial hypertension patients and analyze the relationship of these clinical parameters with the disease severity of pulmonary arterial hypertension. In this study, 23 normal subjects and 23 pulmonary arterial hypertension patients were recruited from January 2015 to March 2016. Pulmonary arterial hypertension patients were classified into moderate and severe pulmonary arterial hypertension groups according to their mean pulmonary arterial pressure levels. All the subjects were subjected to physical examination, chest X-ray, 12-lead electrocardiogram, right heart catheterization, two-dimensional echocardiography, and technetium 99m (99mTc) myocardial perfusion imaging. Compared to normal subjects, the right heart catheterization indexes including right ventricle systolic pressure, right ventricle end diastolic pressure, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, pulmonary vascular resistance, and right ventricle end systolic pressure increased in pulmonary arterial hypertension patients and were correlated with mean pulmonary arterial pressure levels. Echocardiography parameters, including tricuspid regurgitation peak velocity, tricuspid regurgitation pressure gradient, tricuspid annular plane systolic excursion and fractional area, right ventricle-myocardial performance index, were significantly associated with the mean pulmonary arterial pressure levels in pulmonary arterial hypertension patients. Furthermore, myocardial perfusion imaging was not observed in the normal subjects but in pulmonary arterial hypertension patients, especially severe pulmonary arterial hypertension subgroup, and showed potential diagnostic properties for pulmonary arterial hypertension. In conclusion, mean pulmonary arterial pressure levels are correlated with several right heart catheterization and echocardiography markers in pulmonary arterial hypertension patients; echocardiography and 99mTc myocardial perfusion can be used to evaluate right ventricle performance in pulmonary arterial hypertension patients. Impact statement In this study, we analyzed the clinical parameters for evaluating RV function, including right ventricle catheterization (RHC), echocardiography, and technetium 99m (99mTc) myocardial perfusion imaging (MPI) in normal Asian subjects and PAH patients ( n = 23 for each group). Our results demonstrated that six RHC indexes, four echocardiography indexes and MPI index were significantly altered in PAH patients and correlated with the levels of mean pulmonary arterial pressure. Importantly, we evaluated the diagnostic performance of MPI and found that MPI has a strong diagnostic accuracy in PAH patients. The findings from this study will be of interest to clinical investigators who make diagnosis and therapeutic strategies for PAH patients.
Collapse
Affiliation(s)
- Jie Liu
- 1 Department of Nuclear Medicine, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan 430022, China.,2 Hubei Key Laboratory of Molecular Imaging, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan 430022, China
| | - Lei Fei
- 3 Department of Ultrasound Diagnosis, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Guang-Qing Huang
- 3 Department of Ultrasound Diagnosis, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Xiao-Ke Shang
- 4 Department of Cardiac Surgery, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan 430022, China
| | - Mei Liu
- 1 Department of Nuclear Medicine, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan 430022, China.,2 Hubei Key Laboratory of Molecular Imaging, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan 430022, China
| | - Zhi-Jun Pei
- 5 Department of PET Center, Hubei University of Medicine, Taihe Hospital, Shiyan 442000, China
| | - Yong-Xue Zhang
- 1 Department of Nuclear Medicine, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan 430022, China.,2 Hubei Key Laboratory of Molecular Imaging, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan 430022, China
| |
Collapse
|
9
|
Harmonic subtraction for evaluating right ventricle ejection fraction from planar equilibrium radionuclide angiography. Int J Cardiovasc Imaging 2017; 33:1857-1862. [DOI: 10.1007/s10554-017-1164-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
|
10
|
|
11
|
Atehortúa A, Zuluaga MA, García JD, Romero E. Automatic segmentation of right ventricle in cardiac cine MR images using a saliency analysis. Med Phys 2016; 43:6270. [PMID: 27908177 DOI: 10.1118/1.4966133] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Accurate measurement of the right ventricle (RV) volume is important for the assessment of the ventricular function and a biomarker of the progression of any cardiovascular disease. However, the high RV variability makes difficult a proper delineation of the myocardium wall. This paper introduces a new automatic method for segmenting the RV volume from short axis cardiac magnetic resonance (MR) images by a salient analysis of temporal and spatial observations. METHODS The RV volume estimation starts by localizing the heart as the region with the most coherent motion during the cardiac cycle. Afterward, the ventricular chambers are identified at the basal level using the isodata algorithm, the right ventricle extracted, and its centroid computed. A series of radial intensity profiles, traced from this centroid, is used to search a salient intensity pattern that models the inner-outer myocardium boundary. This process is iteratively applied toward the apex, using the segmentation of the previous slice as a regularizer. The consecutive 2D segmentations are added together to obtain the final RV endocardium volume that serves to estimate also the epicardium. RESULTS Experiments performed with a public dataset, provided by the RV segmentation challenge in cardiac MRI, demonstrated that this method is highly competitive with respect to the state of the art, obtaining a Dice score of 0.87, and a Hausdorff distance of 7.26 mm while a whole volume was segmented in about 3 s. CONCLUSIONS The proposed method provides an useful delineation of the RV shape using only the spatial and temporal information of the cine MR images. This methodology may be used by the expert to achieve cardiac indicators of the right ventricle function.
Collapse
Affiliation(s)
| | - Maria A Zuluaga
- Universidad Nacional de Colombia, Bogotá 111321, Colombia and Translational Imaging Group, Centre for Medical Image Computing, University College London, NW1 2PS, United Kingdom
| | - Juan D García
- Universidad Nacional de Colombia, Bogotá 111321, Colombia
| | - Eduardo Romero
- Universidad Nacional de Colombia, Bogotá 111321, Colombia
| |
Collapse
|
12
|
Heiskanen MA, Leskinen T, Heinonen IHA, Löyttyniemi E, Eskelinen JJ, Virtanen K, Hannukainen JC, Kalliokoski KK. Right ventricular metabolic adaptations to high-intensity interval and moderate-intensity continuous training in healthy middle-aged men. Am J Physiol Heart Circ Physiol 2016; 311:H667-75. [PMID: 27448554 DOI: 10.1152/ajpheart.00399.2016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/21/2016] [Indexed: 01/18/2023]
Abstract
Despite the recent studies on structural and functional adaptations of the right ventricle (RV) to exercise training, adaptations of its metabolism remain unknown. We investigated the effects of short-term, high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on RV glucose and fat metabolism. Twenty-eight untrained, healthy 40-55 yr-old-men were randomized into HIIT (n = 14) and MICT (n = 14) groups. Subjects performed six supervised cycle ergometer training sessions within 2 wk (HIIT session: 4-6 × 30 s all-out cycling/4-min recovery; MICT session: 40-60 min at 60% peak O2 uptake). Primary outcomes were insulin-stimulated RV glucose uptake (RVGU) and fasted state RV free fatty acid uptake (RVFFAU) measured by positron emission tomography. Secondary outcomes were changes in RV structure and function, determined by cardiac magnetic resonance. RVGU decreased after training (-22% HIIT, -12% MICT, P = 0.002 for training effect), but RVFFAU was not affected by the training (P = 0.74). RV end-diastolic and end-systolic volumes, respectively, increased +5 and +7% for HIIT and +4 and +8% for MICT (P = 0.002 and 0.005 for training effects, respectively), but ejection fraction mildly decreased (-2% HIIT, -4% MICT, P = 0.034 for training effect). RV mass and stroke volume remained unaltered. None of the observed changes differed between the training groups (P > 0.12 for group × training interaction). Only 2 wk of physical training in previously sedentary subjects induce changes in RV glucose metabolism, volumes, and ejection fraction, which precede exercise-induced hypertrophy of RV.
Collapse
Affiliation(s)
| | | | - Ilkka H A Heinonen
- Turku PET Centre, University of Turku, Turku, Finland; School of Sport Science, Exercise and Health, University Of Western Australia, Crawley, Western Australia, Australia; and
| | | | | | | | | | | |
Collapse
|
13
|
Leng S, Jiang M, Zhao XD, Allen JC, Kassab GS, Ouyang RZ, Tan JL, He B, Tan RS, Zhong L. Three-Dimensional Tricuspid Annular Motion Analysis from Cardiac Magnetic Resonance Feature-Tracking. Ann Biomed Eng 2016; 44:3522-3538. [PMID: 27436293 DOI: 10.1007/s10439-016-1695-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/07/2016] [Indexed: 02/04/2023]
Abstract
Right ventricular (RV) dysfunction is known to be highly correlated with mortality and morbidity; nevertheless, imaging-based assessment of RV anatomy and physiology lags far behind that of the left ventricle. In this study, we advance RV imaging using cardiac magnetic resonance (CMR) to accomplish the following aims: (i) track the motion of six tricuspid annular (TA) sites using a semi-automatic tracking system; (ii) extract clinically important TA measurements-systolic velocity (Sm), early diastolic velocity (Em), late diastolic velocity (Am), and TA plane systolic excursion (TAPSE)-for each TA site and compare these CMR-derived measurements in healthy subjects vs. patients with heart failure, repaired tetralogy of Fallot, pulmonary hypertension, and hypertrophic cardiomyopathy; (iii) investigate how the TA motion related measurements compare with information provided by invasive right heart catheterization (RHC); (iv) evaluate the rate of change in surface area swept out by the reconstructed tricuspid annulus over time and (v) assess the reproducibility of this CMR-based technique. Results indicate that TA motion parameter data obtained in three dimensions using the proposed CMR-based systematic methodology achieve superior diagnostic performance (Sm: AUC = 0.957; TAPSE: AUC = 0.981) compared to two-dimensional CMR imaging. Both Sm and TAPSE from CMR correlated positively with dP/dt max/IP from RHC (Sm: r = 0.621, p < 0.01; TAPSE: r = 0.648, p < 0.01). Our highly reproducible and robust methodology holds potential for extending CMR imaging to characterization of TA morphology and dynamic behaviour, eventually leading to deeper understanding of RV function and improved diagnostic capability.
Collapse
Affiliation(s)
- Shuang Leng
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Meng Jiang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China
| | - Xiao-Dan Zhao
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - John Carson Allen
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, 92121, USA
| | - Rong-Zhen Ouyang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China
| | - Ju-Le Tan
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Ben He
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China.
| | - Ru-San Tan
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Liang Zhong
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore. .,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
| |
Collapse
|
14
|
Deveci B, Baser K, Gul M, Sen F, Kafes H, Avci S, Temizer O, Ozeke O, Tufekcioglu O, Golbasi Z. Right ventricular outflow tract function in chronic heart failure. Indian Heart J 2016; 68 Suppl 1:S10-4. [PMID: 27056647 PMCID: PMC4824327 DOI: 10.1016/j.ihj.2015.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 07/07/2015] [Accepted: 07/14/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a common, progressive, complex clinical syndrome and a subset of HF patients has symptoms out of proportion to the resting hemodynamics and left ventricular ejection fraction (LVEF). Right ventricular (RV) function is a powerful prognostic factor in HF, but assessing it is a challenge because of the right ventricle's complex geometry. OBJECTIVE The aim of this study was to investigate the clinical application value of RV outflow tract (RVOT) function measured by transthoracic echocardiography in HF patients. METHOD We prospectively investigated 36 chronic HF patients with dilated heart and LV systolic dysfunction and 21 healthy control subjects (normal ventricular function and ECG, and no cardiac risk factors). In addition to clinical and conventional echocardiographic parameters, RVOT size and fractional shortening (RVOT-FS) parameters were analyzed. RESULTS The RVOT-FS was less in HF patients than healthy controls (18.8±15.7 vs 55.8±6.7, p<0.001) and correlated positively with TAPSE (r=0.814, p<0.001) and inversely with SPAP (r=-0.728, p<0.001) and functional capacity (r=-0.842, p<0.001). There was a statistically significant difference in RVOT-FS among the HF subgroups with regard to NYHA functional capacity (p<0.001), although there was no statistically significant difference with regard to LVEF. CONCLUSION Although the apparent discordance between LVEF and the degree of functional impairment in HF is not well understood, it may be explained in part by alterations in RV function. We found that the RVOT-FS was a noninvasive and easily applicable measure of RV function and might be used for a comprehensive evaluation and follow-up of HF patients with a combined assessment of RV by other RV parameters.
Collapse
Affiliation(s)
- Bulent Deveci
- Akay Hospital, Department of Cardiology, Ankara, Turkey
| | - Kazim Baser
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Murat Gul
- Van Ercis State Hospital, Department of Cardiology, Van, Turkey
| | - Fatih Sen
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Habibe Kafes
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Sedat Avci
- Tatvan State Hospital, Department of Cardiology, Bitlis, Turkey
| | - Orkun Temizer
- Burdur State Hospital, Department of Cardiology, Burdur, Turkey
| | - Ozcan Ozeke
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey.
| | - Omac Tufekcioglu
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Zehra Golbasi
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey
| |
Collapse
|
15
|
Rihal CS, Naidu SS, Givertz MM, Szeto WY, Burke JA, Kapur NK, Kern M, Garratt KN, Goldstein JA, Dimas V, Tu T. 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care (Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention). J Card Fail 2016; 21:499-518. [PMID: 26036425 DOI: 10.1016/j.cardfail.2015.03.002] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella(®); left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for right-sided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines.
Collapse
Affiliation(s)
- Charanjit S Rihal
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
| | - Srihari S Naidu
- Division of Cardiology, Winthrop University Hospital, Mineola, New York
| | - Michael M Givertz
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Wilson Y Szeto
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James A Burke
- Division of Cardiology, Lehigh Valley Heart Specialists, Allentown, Pennsylvania
| | - Navin K Kapur
- Cardiology, Tufts Medical Center, Boston, Massachusetts
| | - Morton Kern
- Division of Cardiology, UCI Medical Center, Orange, California
| | - Kirk N Garratt
- Department of Cardiac and Vascular Services, Heart and Vascular Institute of New York, Lenox Hill Hospital, New York, New York
| | - James A Goldstein
- Division of Cardiology, Beaumont Heart Center Clinic, Royal Oak, Michigan
| | - Vivian Dimas
- Pediatric Cardiology, UT Southwestern, Dallas, Texas
| | - Thomas Tu
- Louisville Cardiology Group, Interventional Cardiology, Louisville, Kentucky
| | | | | | | | | | | |
Collapse
|
16
|
2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care. J Am Coll Cardiol 2015; 65:e7-e26. [DOI: 10.1016/j.jacc.2015.03.036] [Citation(s) in RCA: 354] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
17
|
Rihal CS, Naidu SS, Givertz MM, Szeto WY, Burke JA, Kapur NK, Kern M, Garratt KN, Goldstein JA, Dimas V, Tu T. 2015 SCAI/ACC/HFSA/STS clinical expert consensus statement on the use of percutaneous mechanical circulatory support devices in cardiovascular care (Endorsed by the American heart assocation, the cardiological society of India, and sociedad latino America. Catheter Cardiovasc Interv 2015; 85:E175-96. [DOI: 10.1002/ccd.25720] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 10/25/2014] [Indexed: 12/20/2022]
Affiliation(s)
| | - Srihari S. Naidu
- Division of Cardiology; Winthrop University Hospital; Mineola New York
| | | | - Wilson Y. Szeto
- Department of Surgery; University of Pennsylvania; Philadelphia Pennsylvania
| | - James A. Burke
- Division of Cardiology; Lehigh Valley Heart Specialists; Allentown, PA
| | | | - Morton Kern
- Division of Cardiology; UCI Medical Center; Orange CA
| | - Kirk N. Garratt
- Department of Cardiac and Vascular Services, Heart and Vascular Institute of New York; Lenox Hill Hospital; New York New York
| | - James A. Goldstein
- Division of Cardiology; Beaumont Heart Center Clinic; Royal Oak Michigan
| | - Vivian Dimas
- Pediatric Cardiology; UT Southwestern; Dallas Texas
| | - Thomas Tu
- Louisville Cardiology Group; Interventional Cardiology; Louisville Kentucky
| | | |
Collapse
|
18
|
Effects of filtration on right ventricular function by the gated blood pool SPECT. Ann Nucl Med 2015; 29:384-90. [PMID: 25636982 DOI: 10.1007/s12149-015-0949-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 01/14/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Gated blood po ol single photon emission computed tomography (GBPS) offers the possibility of obtaining additional functional information from blood pool studies, including evaluation of left and right ventricular function simultaneously. The calculation of ventricular volumes based on the identification of the endocardial surface would be influenced by the spatial resolution in the reconstructed images. This study was performed to evaluate the effect of different filters on the right ventricular function. METHODS The normal four-dimensional (4-D) NURBS-based cardiac-torso (NCAT) phantom with known right ventricular volume and ejection fraction was generated. The SIMIND Monte Carlo program was used to create projections. The studies were reconstructed by FBP and post-processing filtration such as Butterworth, Hanning, Shepp-Logan, Metz and Wiener in different statuses (cutoff and order). Using the Cedars-Sinai QBS (quantitative blood pool SPECT) package, the ventricular functional parameters were computed. The calculated values were analyzed and compared with the normal NCAT results. RESULTS The results implied that the calculated right ventricular end diastolic volume (RVEDV) by Butterworth filtration (cutoff frequency = 0.3) agreed more with the NCAT Phantom characteristics [relative difference percentage (RDP) = 1.2 %], while the maximum accordance in the calculation of the RV ejection fraction (EF) (RDP = 3 %) was observed by Metz filter (FWHM 20 pixel). Also, the results of this study demonstrate that the Butterworth filter provided the most stable values (cutoff frequency = 0.4-0.5) in the estimation of RVEDV (RDP = 7.5 %). The Hanning and Shepp-Logan filters produced a much larger RDP, particularly in low frequency (41.1 and 21.5 %, respectively) compared to other filters. CONCLUSIONS This study demonstrated that the operation of different filters has a severe effect in computing right ventricular volume. The resolution recovery and Butterworth filters tend to give more comparable ventricular volumes with the actual normal NCAT value. Further evaluation using a large clinical database is underway to evaluate the optimum protocol in a clinical setting.
Collapse
|
19
|
Singh J, Borgstrom M, Abidov A. Coronary Computed Tomography Angiography-Based Tricuspid Annular Plane Systolic Excursion: Correlation with 2D Echocardiography. Echocardiography 2014; 31:773-8. [DOI: 10.1111/echo.12461] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jaspreet Singh
- Division of Cardiology; The University of Arizona College of Medicine; Tucson Arizona
| | - Mark Borgstrom
- Division of Cardiology; The University of Arizona College of Medicine; Tucson Arizona
| | - Aiden Abidov
- Division of Cardiology; The University of Arizona College of Medicine; Tucson Arizona
| |
Collapse
|
20
|
Wang L, Zhang Y, Yan C, He J, Xiong C, Zhao S, Fang W. Evaluation of right ventricular volume and ejection fraction by gated (18)F-FDG PET in patients with pulmonary hypertension: comparison with cardiac MRI and CT. J Nucl Cardiol 2013; 20:242-52. [PMID: 23354658 DOI: 10.1007/s12350-013-9672-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Right ventricular (RV) function is a powerful predictor of survival in patients with pulmonary hypertension (PH), but noninvasively assessing RV function remains a challenge. The aim of this study was to prospectively compare gated (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) myocardial imaging (gated PET), cardiac magnetic resonance (CMR), and cardiac computed tomography (CCT) for the assessment of RV volume and ejection fraction in patients with PH. METHODS Twenty-three consecutive patients aged more than 16 years diagnosed with PH were included. All patients underwent gated PET, CMR, and CCT within 7 days. Right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), and right ventricular ejection fraction (RVEF) were calculated by three imaging modalities. RV (18)F-FDG uptake was determined as RV-corrected standardized uptake value (SUV), and the ratio of RV to left ventricular (LV)-corrected SUV (Corrected SUV R/L). RESULTS Gated PET showed a moderate correlation (r = 0.680, P < .001) for RVEDV, good correlation for RVESV (r = 0.757, P < .001) and RVEF (r = 0.788, P < .001) with CMR, and good correlation for RVEDV (r = 0.767, P < .001), RVESV (r = 0.837, P < .001), and RVEF (r = 0.730, P < .001) with CCT. Bland-Altman analysis revealed systematic underestimation of RVEDV and RVESV and overestimation of RVEF with gated PET compared with CMR and CCT. The correlation between RVESV (r = 0.863, P < .001), RVESV (r = 0.903, P < .001), and RVEF (r = 0.853, P < .001) of CMR and those of CCT was excellent; Bland-Altman analysis showed only a slight systematic variation between CMR and CCT. There were statistically significant negative correlations between RV-corrected SUV and RVEF-CMR (r = -0.543, P < .01), Corrected SUV R/L and RVEF-CMR (r = -0.521, P < .05), RV-corrected SUV and RVEF-CCT (r = -0.429, P < .05), Corrected SUV R/L and RVEF-CCT (r = -0.580, P < .01), respectively. CONCLUSION Gated PET had moderate-to-high correlation with CMR and CCT in the assessments of RV volume and ejection fraction. It is an available method for simultaneous assessing of RV function and myocardial glucose metabolism in patients with PH.
Collapse
Affiliation(s)
- Lei Wang
- Department of Nuclear Medicine, Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China
| | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
Right ventricular (RV) function is a strong independent predictor of outcome in a number of distinct cardiopulmonary diseases. The RV has a remarkable ability to sustain damage and recover function which may be related to unique anatomic, physiologic, and genetic factors that differentiate it from the left ventricle. This capacity has been described in patients with RV myocardial infarction, pulmonary arterial hypertension, and chronic thromboembolic disease as well as post-lung transplant and post-left ventricular assist device implantation. Various echocardiographic and magnetic resonance imaging parameters of RV function contribute to the clinical assessment and predict outcomes in these patients; however, limitations remain with these techniques. Early diagnosis of RV function and better insight into the mechanisms of RV recovery could improve patient outcomes. Further refinement of established and emerging imaging techniques is necessary to aid subclinical diagnosis and inform treatment decisions.
Collapse
Affiliation(s)
- Evan L Brittain
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | | | | | | | | |
Collapse
|
22
|
Mandapaka S, Hamilton CA, Morgan TM, Hundley WG. Simultaneous measurement of left and right ventricular volumes and ejection fraction during dobutamine stress cardiovascular magnetic resonance. J Comput Assist Tomogr 2011; 35:614-7. [PMID: 21926858 DOI: 10.1097/rct.0b013e31822abbcd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE During cardiovascular stress, if right ventricular (RV) stroke volume exceeds left ventricular (LV) stroke volume, then a large volume of blood is displaced into the pulmonary circulation that may precipitate pulmonary edema. We sought to determine the metrics by which cardiovascular magnetic resonance (CMR) could measure simultaneous displacement of RV and LV stroke volumes during dobutamine stress. METHODS Thirteen healthy subjects (5 women) aged 53 ± 10 years without medical conditions and taking no medications underwent 2 CMR examinations at 1.5 T separated by 4 to 8 weeks in which RV and LV stroke volumes were determined during intravenous dobutamine and atropine infused to achieve 80% of the maximum predicted heart rate response for age. RESULTS The RV and LV stroke volumes were highly correlated at each level of stress (rest: r = 0.98, P = 0.007; low stress: r = 0.87, P = 0.001; and peak stress: r = 0.88, P = 0.001), and the mean difference in SV at each level of stress (rest, low stress, and peak stress was 0 to 2 mL on examinations 1 and 2. CONCLUSIONS Simultaneous change in right and left ventricular stroke volumes can be assessed in a highly reproducible manner throughout the course of dobutamine CMR stress administered to achieve 80% of maximum predicted heart rate response for age. This technology may help identify discrepancies in RV and LV stroke volumes during cardiovascular stress that are associated with the development of pulmonary edema.
Collapse
Affiliation(s)
- Sangeeta Mandapaka
- Department of Internal Medicine (Cardiology Section), Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | | | | | | |
Collapse
|
23
|
Weininger M. Subjective assessment of right ventricle enlargement from computed tomography pulmonary angiography images. Int J Cardiovasc Imaging 2011; 28:975-7. [DOI: 10.1007/s10554-011-9909-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 06/09/2011] [Indexed: 12/01/2022]
|